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NOTES TO THE RADIOLOGIST

Comparisons: [ ]

Procedure: T1 and T2 weighted images in multiple planes were obtained through the pelvis. Diffusion-weighted images were obtained through the uterus. [ ]cc of MultiHance were administered as the intravenous contrast agent.

Findings:

UTERUS: [Describe other uterine findings, other than the tumor, here]

UTERINE SIZE: [3 dimensions]

TUMOR SIZE INDEX: [Give the PRODUCT of 3 dimensions, unless the tumor is too small or ill-defined to measure, then dictate: tumor too small or to ill-defined to measure. Eg: 2cm x 2cm x 5cm = 20]

Tumor size will be given as an index which = length x width x height of the tumor. They are using a cut off of 36 as a tumor volume index to decide treatment plan. See reference Todo et al Gyne Onc 2007.

MYOMETRIAL INVASION: [no significant myometrial invasion] [less than 50% myometrial wall thickness invasion] [greater than 50% myometrial wall thickness invasion]

Find the area of greatest invasion on the T2, Post-contrast and DWI images and measure the distance from the junctional zone to the serosa, as pictured below. In cases where it is hard to see the junctional zone, estimate and note the limitations.

[pic]

The invasion ratio was tumor invasion depth (B) divided by myometrial thickness (A+B) (Lin et.al. Myometrial Invasion in Endometrial Cancer. Radiology:250:3: 784-792)

LOCATION OF THE DEEPEST EXTENT OF MYOMETRIAL INVASION: [right/left], [anterior/posterior] [fundal, body, lower uterine segment]

EXTENSION of tumor into the cornua: [No; left/right cornua.]

The referring physicians need to be alerted to the “extension” of tumor and “gross invasion”, such as if you see the tumor invading through to the serosa or out into the adnexa.

EXTENSION of the tumor into the cervix stroma: [yes/no/indeterminate]

The referring physicians are most concerned about “gross” invasion, which you can see without a doubt. If it’s questionable invasion, then it can be noted as such.

DISTANCE of the tumor from the cervical canal: [give measurement if possible]

This is for path correlation, so it is not used currently for clinical decision making. If you can’t measure it, just note it as such.

OVARIES: The ovaries are [not visualized/visualized] and are [normal/abnormal] in appearance. [If abnormal describe].

LYMPH NODES:

Pelvis: [no/few/many];[The largest pelvic lymph node is located (give location) and measures (give size).] Para-aortic nodes: [no/few/many]; [The largest para-aortic node measures (give size)].

ADDITIONAL COMMENTS: [provide your impression of whether or not these lymph nodes are abnormal]

Size criteria for calling abnormal lymph nodes: 8-10mm

However, if the lymph node is round or irregular, central necrosis, these morphologic features trump size criteria (i.e. call an abnormal node with these criteria, regardless of size).

(McMahon CJ, Rofsky NM, Pedrosa I. Lymphatic metastases from pelvic tumors: anatomic classification, characterization, and staging. Radiology 254(1): 31-46.)

Impression: Endometrial cancer as described in detail above.

[You can provide your summary so they know the pertinent findings if you like; eg. Tumor difficult to visualize, with no apparent myometrial or cervical invasion. Single mildly enlarged lymph node along the left pelvis, adjacent to the left external iliac vessels, indeterminate.]

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